神经科

订阅

MedSci主页 / 所有栏目 / 神经科

Neurol：你的拇指上翘了吗？

2017-08-15 杨中华 脑血管病及重症文献导读

Babinski征|Hoffmann征拇指上翘征TIA卒中
关注

1985年Hachinski V给一个偏头痛相关脑梗死患者查体发现，当患者手掌朝下五指伸直时拇指伸展，他把这个现象称为拇指征。随后，他让患者双掌相对，他发现伸展的拇指（extended thumb）变为了拇指上翘（upgoing thumb），这个与伸跖反应相对应。

1985年Hachinski V给一个偏头痛相关脑梗死患者查体发现，当患者手掌朝下五指伸直时拇指伸展，他把这个现象称为拇指征。随后，他让患者双掌相对，他发现伸展的拇指（extended thumb）变为了拇指上翘（upgoing thumb），这个与伸跖反应相对应。

19世纪晚期和20世纪早期是神经系统疾病(包括系统性描述和分类)发展的黄金时期。这多归功于Jean-Martin Charcot和他的学生们，包括Joseph Babinski。1896年，在法国举行的一次生物学会议上Babinski(1857-1932)介绍了Babinski征，他发现刺激痉挛性偏瘫患者的足跖面可以导致大拇趾伸展。从此以后，大约发现了30多种Babinski征的下肢等位征，但是Babinski征仍然是神经病学查体的标准。几项研究也发现Babinski征是脑和脊髓皮质脊髓束受累的敏感指标。

目前绝大部分神经科医生仍然习惯于评价下肢的反射异常，但是上肢反射也有报道。Johann Hoffmann (1857–1919)更精确地说是他的助理Curschmann于 1911年发现轻弹或突发释放第2、3、4手指时大拇指末节会弯曲。这个现象可以见于正常人，但是完全阳性试验(所有手指皆弯曲)以及双侧Hoffman反射不对称可以见于颈髓或以上水平上运动神经元病变。但是不能单独采用Hoffmann征筛查脑和颈髓的上运动神经元病变。

1985年Hachinski V给一个偏头痛相关脑梗死患者查体发现，当患者手掌朝下五指伸直时拇指伸展，他把这个现象称为拇指征。随后，他让患者双掌相对，他发现伸展的拇指(extended thumb)变为了拇指上翘(upgoing thumb)，这个与伸跖反应相对应。


A图，手休息位时左侧为拇指上翘征;


B图，上肢平举至肩时，左侧为拇指上翘征

以前研究报道过TIA和卒中患者的拇指上翘征(upgoing thumb sign)。2017年来自加拿大的Vladimir Hachinski等在Neurology上发文，目的在于比较卒中或TIA vs 假卒中(stroke mimics)患者拇指上翘征的发生率。

最终他们发现拇指上翘征更常见于小卒中/TIA患者(vs 假卒中)。

问候语：你的拇指上翘了吗?≈ 你脑子有病吧!

也有人说这叫“点赞”征。

原始出处：

Hachinski V, Alsubaie R, Azarpazhooh MR. Upgoing thumb sign: A sensitive indicator of brain involvement? Neurology. 2017 Jul 25;89(4):370-375. doi: 10.1212/WNL.0000000000004157. Epub 2017 Jun 28.

版权声明：
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料，版权均属于梅斯医学所有。非经授权，任何媒体、网站或个人不得转载，授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章，或“梅斯号”自媒体发布的文章，仅系出于传递更多信息之目的，本站仅负责审核内容合规，其内容不代表本站立场，本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系，我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2000072, encodeId=ce7b20000e2cf, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Nov 03 11:54:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235634, encodeId=dc0c23563495, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Mon Aug 21 08:26:20 CST 2017, time=2017-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=234120, encodeId=d84623412036, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋，懒，贪, createdTime=Wed Aug 16 14:08:47 CST 2017, time=2017-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233964, encodeId=c71323396435, content=俏皮的翻译，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Wed Aug 16 07:05:14 CST 2017, time=2017-08-16, status=1, ipAttribution=)]
    2017-11-03 yinhl1978

    #Neurol#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2000072, encodeId=ce7b20000e2cf, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Nov 03 11:54:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235634, encodeId=dc0c23563495, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Mon Aug 21 08:26:20 CST 2017, time=2017-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=234120, encodeId=d84623412036, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋，懒，贪, createdTime=Wed Aug 16 14:08:47 CST 2017, time=2017-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233964, encodeId=c71323396435, content=俏皮的翻译，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Wed Aug 16 07:05:14 CST 2017, time=2017-08-16, status=1, ipAttribution=)]
    2017-08-21 meiliwuxian

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2000072, encodeId=ce7b20000e2cf, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Nov 03 11:54:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235634, encodeId=dc0c23563495, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Mon Aug 21 08:26:20 CST 2017, time=2017-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=234120, encodeId=d84623412036, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋，懒，贪, createdTime=Wed Aug 16 14:08:47 CST 2017, time=2017-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233964, encodeId=c71323396435, content=俏皮的翻译，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Wed Aug 16 07:05:14 CST 2017, time=2017-08-16, status=1, ipAttribution=)]
    2017-08-16 戒馋，懒，贪

    赞

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2000072, encodeId=ce7b20000e2cf, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Nov 03 11:54:00 CST 2017, time=2017-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235634, encodeId=dc0c23563495, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Mon Aug 21 08:26:20 CST 2017, time=2017-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=234120, encodeId=d84623412036, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋，懒，贪, createdTime=Wed Aug 16 14:08:47 CST 2017, time=2017-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233964, encodeId=c71323396435, content=俏皮的翻译，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Wed Aug 16 07:05:14 CST 2017, time=2017-08-16, status=1, ipAttribution=)]
    2017-08-16 baihao215

    俏皮的翻译，学习了

    0